3 He‐MRI‐based vs. conventional determination of lung volumes in patients after unilateral lung transplantation: a new approach to regional spirometry

Background: To use 3 Helium ( 3 He)‐MRI in patients with unilateral lung grafts to assess the contributions of graft and native lung to total ventilated lung volume, and second to compare conventional measurements of intrapulmonary gas volume (spirometry, body plethysmography) with image‐based volumetry of ventilated lung parenchyma visualized by hyperpolarized 3 He‐MRI. Methods: With Ethics Committee approval, five patients with single lung transplantation (SLTX) for idiopathic pulmonary fibrosis (IPF) underwent both conventional pulmonary function testing (PFT) and 3 He‐MRI of the lung. Intrapulmonary gas volume (GV) during the inspiratory breathhold for 3 He‐MRI was calculated from measured functional residual capacity (corrected for supine position) and inspired tidal volume. Image‐based global and regional lung volumetries (LV) were performed in three‐dimensionally reconstructed 3 He‐MR images (corrected for the fraction of tissue and blood). Results: Transplanted lungs were characterized by a homogeneous distribution of signal intensity, whereas the native lungs of the patients suffering from IPF displayed an inhomogeneous signal distribution pattern with numerous round or wedge‐shaped ventilation defects. Total ventilated lung volume determined by 3 He‐MRI correlated well with PFT‐based measurements, but with a systematic overestimation of the 3 He‐based lung volumetry of approximately 20%. Functioning lung grafts contributed 66±6% and their corresponding native IPF lungs 34±6% to total ventilated volume ( P< 0.05; mean±SD). Conclusion:3 Helium‐MRI of the lung offers a novel approach to regional determination of ventilated lung volume, including its blood and tissue compartments. The advantage of this technique over computed tomography or ventilation scintigraphy is the lack of radiation exposure, and hence its repeatability. Follow up of SLTX patients with this new technique may allow the monitoring of functional and structural developments of grafted lungs with better sensitivity and specificity than PFT.